This essay will critically analyse the
implementation of a public health intervention to combat poor oral health
amongst children in the borough of Hammersmith
and Fulham. Tooth decay is a result of poor oral health and
is the most common oral disease affecting children
and young people in England despite its being a preventable health issue in the
UK. It will also look at how this public health project is developed and
delivered using locally available resources. 
Systematic and structured planning of implementation projects are
important in public health, because the aim is to prevent or reduce a
particular health problem, or the determinants of the problem, within a
population group and manage it cost effectively. It will also help health
professionals plan, implement, and evaluate public health programs better.
Program planning models serve to organize the steps for a health promotion with
the main goal on improving quality of life. 
This may aim to will impact on the lives of a large group of people and
so the reasoning and expected outcomes must be planned with judgment.  (Wight, et
al., 2016).



Planning and Implementation Models

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The PRECEDE-PROCEED model is a structured
outline for assessing health needs in order to design, implement and evaluate
health promotion and other public health programs to meet those needs. The PRECEDE
acronym gives guidance on planning a targeted public health program and
recognises the multiple determinants of health, while the PROCEED acronym
provides a structured plan for the implementation and evaluation of the public
health program. PRECEDE stands for “Predisposing, Reinforcing, and Enabling
Constructs in Educational Diagnosis and Evaluation”. This stage involves
assessing community factors such as social assessment, epidemiological
assessment, ecological assessment and implementations. PROCEED stands for “Policy,
Regulatory, and Organizational Constructs in Educational and Environmental
Development”. This stage of the model involves looking at the desired outcomes
and how to implement the intervention.  (Gielen & Eileen, 1996; Naidoo & Wills, 2016).


In setting up a
project focused on this health issue the PRECEDE component can be applied
through social assessment. This is done by bringing together public
agencies and organisations to establish the extent to which poor oral health is
prevalent in local areas and to ask questions about planning for better
outcomes from services. By conducting
this assessment and asking important questions such “Are commissioned
programmes appropriate to local needs, informed by local information and
intelligence and supported by the best available evidence?” desirable outcomes can be identified. This
planning model can be applied in oral health, however the same goal of
organising the framework for the oral health can be achieved with planning
models such as RE-AIM and the Stage Model of Behavioural Therapy (Binkley & Johnson,


Once the
education skills and ecology questions are identified through asking a series
of questions based on the current picture of oral health in young children the
next stage is the implementation which involves the PROCEED aspect. The PROCEED
component of the model encompasses what policies can be implemented to achieve
the desired outcome. An example of how the poor oral hygiene in this London
borough can be addressed is the “Building Brighter Smiles”. In order for
this implementation to be successful it required the council commissions a
series of oral health improvement programmes and the use of hair care
professionals such as health visitors to enforce it and involving schools in
educating young children about dental health (Local Government Association,


Unlike behavioural theories, the main goal
of the PRECEDE-PROCEED Model (PPM) is not to predict or explain the
relationship among factors that are linked with an outcome of interest or tests
mechanisms of action. Its main purpose is to provide a structure for applying
theories and concepts systematically in order to aid planning and evaluating of
health behaviour change programs (Glanz, 2008). The PPM is very
much an “ecological approach to health promotion as it assess environmental
factors and how that effects a person’s development environment in order to
investigate what needs to change to achieve”. It is a straightforward model
compared to others as it embodies two key aspects of intervention which are planning,
and evaluation. This approach is beneficial as it provides context to the use
of theory (Crosby & Noar, 2011).


Partners and Stakeholders


The partners and stakeholders involved in
a public health intervention like the oral health programme include the local
authority. This responsibility was passed down from the NHS to them to enable for
councils to further develop relationships with key partners such as “health
visitors, family nurses, midwives, school nurses, dental teams, GPs, children’s
centre staff and commissioning groups”. They place a strong emphasis on the importance
of using intervention planning models such as PPM and strongly encourage
investigators to utilize methods that allow for a test of mechanisms of action.
Oral health surveys allow the ability for them to do that through assessing and
monitoring to aid planning and evaluation of any implementations applied (Binkley & Johnson, 2013; Local Government
Association, 2016).

In order for his implementation to be a
success the local authority plan to develop a locally tailored oral health
strategy based on the results of the evaluation. They also plan to increase
the awareness of local leadership and advocacy for oral health improvement at
all levels. This includes using elected members, strategic leadership through
the Health and Well-being Board and council public health teams. Other groups
that will be involved in the success of this public health intervention include
Health leadership through NHS England area teams, dental Local Professional
Networks (LPNs), and Committees (LDCs) (Local Government Association,




To conclude an oral health strategy was evaluated
and planned to target young children with poor oral health. The PPM can be
utilised to form the logical formulation of the desired outcomes and end point
and provide the ability to work “backwards” to achieve that goal through
community participation and involve everyone at all levels from the health care
professional to the families and children.








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